Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Rev Saude Publica. 2011 Oct;45(5):938-48. doi: 10.1590/s0034-89102011005000049. Epub 2011 Jul 29.
To analyze the evolution of drug use among treated crack cocaine users.
A cohort originally comprising 131 crack addicts admitted to a detoxification unit in the city of São Paulo, Southeastern Brazil, between 1992 and 1994 were followed up on three occasions: 1995-96, 1998-99, and 2005-06. Variables investigated included demographical data, risky sexual behaviors, intake patterns for crack and other substances, incarceration, disappearance, and death. Statistical analysis was carried out using chi-square tests, multinomial logistic regression and Cox regression.
Among the patients evaluated, 43 were crack-free (12 months or longer), 22 were users, 13 were imprisoned, two were missing, and 27 were deceased. Three groups with distinct post-discharge drug use patterns were identified. Safe sexual behavior (condom use) was correlated with stable abstinence (p=0.001). Positive HIV test upon admission (p=0.046), use of snorted cocaine in the last year (p=0.001), and lifetime use of snorted cocaine (132 months or longer) (p=0.000) were associated with long term use of crack cocaine. History of intravenous cocaine use increased the probability of death at 12 years by 2.5 fold (p=0.031) (95%CI: 1.08; 5.79).
Recurrence and persistence of crack use in the years following discharge reflect new modalities of drug use. On the other hand, stable abstinence patterns provide evidence of the feasibility of recovery from crack addiction.
分析接受治疗的可卡因吸食者的药物使用演变情况。
1992 年至 1994 年期间，巴西东南部城市圣保罗的一个戒毒单位共收治了 131 名可卡因成瘾者，该队列对他们进行了三次随访：1995-1996 年、1998-1999 年和 2005-2006 年。调查的变量包括人口统计学数据、危险性行为、吸食可卡因和其他物质的模式、监禁、失踪和死亡。采用卡方检验、多项逻辑回归和 Cox 回归进行统计学分析。
在所评估的患者中，43 人无可卡因（12 个月或更长时间），22 人是使用者，13 人被监禁，2 人失踪，27 人死亡。确定了三种具有不同出院后药物使用模式的群体。安全的性行为（使用避孕套）与稳定的禁欲（p=0.001）相关。入院时 HIV 检测呈阳性（p=0.046）、去年使用可卡因粉末（p=0.001）和终生使用可卡因粉末（132 个月或更长时间）（p=0.000）与长期使用可卡因有关。静脉内可卡因使用史使 12 年的死亡风险增加了 2.5 倍（p=0.031）（95%CI：1.08；5.79）。
出院后多年可卡因复发和持续使用反映了新的药物使用模式。另一方面，稳定的禁欲模式为可卡因成瘾康复的可行性提供了证据。
